Three-dimensional residual channel attention networks denoise and sharpen fluorescence microscopy image volumes.

We demonstrate residual channel attention networks (RCAN) for the restoration and enhancement of volumetric time-lapse (four-dimensional) fluorescence microscopy data. First we modify RCAN to handle image volumes, showing that our network enables denoising competitive with three other state-of-the-art neural networks. We use RCAN to restore noisy four-dimensional super-resolution data, enabling image capture of over tens of thousands of images (thousands of volumes) without apparent photobleaching. Second, using simulations we show that RCAN enables resolution enhancement equivalent to, or better than, other networks. Third, we exploit RCAN for denoising and resolution improvement in confocal microscopy, enabling ~2.5-fold lateral resolution enhancement using stimulated emission depletion microscopy ground truth. Fourth, we develop methods to improve spatial resolution in structured illumination microscopy using expansion microscopy data as ground truth, achieving improvements of ~1.9-fold laterally and ~3.6-fold axially. Finally, we characterize the limits of denoising and resolution enhancement, suggesting practical benchmarks for evaluation and further enhancement of network performance.

Ventriculitis after emergent arch aneurysm surgery.

A 72-year-old man was referred to our institution because of an arch aneurysm and acute aortic dissection (thrombosed Stanford type A). Anti-impulse therapy was initiated. He developed a high fever after admission. Blood culture was negative. Five days after admission, he developed back pain. Thoracoabdominal computed tomography revealed a new low-density area from the distal arch to the descending aorta. We performed emergent total arch replacement. Although we discontinued all sedative drugs after surgery, coma continued. Brain magnetic resonance imaging with diffusion-weighted imaging revealed ventriculitis with brain infarction. After antimicrobial therapy was started, his consciousness level improved. Ventriculitis should be suspected when disturbance of consciousness continues longer than we predict after emergent arch aneurysm surgery. Delay in diagnosis can lead to a life-threatening condition.

[Simultaneous Transapical Transcatheter Aortic Valve Implantation and Coronary Artery Bypass Grafting;Report of a Case].

Coronary artery disease(CAD) is often found concurrently in patients presenting with severe aortic stenosis(AS). Surgical aortic valve replacement(SAVR) and coronary artery bypass grafting(CABG) were usually selected with such patients. Recently, transcatheter aortic valve implantation (TAVI) is considered as a less invasive and more feasible treatment option in high-risk AS patients. A 74-year-old woman admitted due to acute myocardial infarction and treated with percutaneous coronary intervention revealed severe AS. Because of her comorbidities, concomitant transapical TAVI and CABG were performed with an excellent clinical course.

Confocal laser displacement sensor using a micro-machined varifocal mirror.

A confocal laser displacement sensor using a micro-machined varifocal mirror is reported. The focal length modulation is a key function of the confocal sensor. The mechanism of the focal length modulation determines the measurement speed and range. Here, we propose application of the micro-machined varifocal mirror for the modulation. The varifocal mirror can realize faster modulation, small size, and low energy consumption for the confocal displacement sensor. The electrostatically actuated varifocal mirror made by single crystalline silicon is used. The working distance of the sensor is designed to be 31 mm. The actuating range at 7 kHz is 310 µm. The linearity error in the actuating range is from -1.1% to 1.2%.

Effects of Components of PM2.5 Collected in Japan on the Respiratory and Immune Systems.

Epidemiologic studies have reported that particulate matter with aerodynamic diameters ≤2.5 µm (PM2.5) affect respiratory diseases, including asthma. The components and/or factors of PM2.5 that contribute to the exacerbation of asthma have not been identified. We investigated the effects of extracts of PM2.5 collected in Japan on the respiratory and immune systems. PM2.5 was collected from an industrial area and an urban area in December 2013. Airway epithelial cells and immune cells were exposed to aqueous or organic extracts of PM2.5. Exposure to extracts from both areas, especially to organic extracts rather than aqueous extracts, caused a pro-inflammatory response via interleukin (IL) 6 production from airway epithelial cells, and it induced the maturation/activation of bone marrow-derived antigen-presenting cells via dendritic and epithelial cell (DEC) 205 and cluster of differentiation (CD) 86 expression and proportional changes in the constitution of the splenocytes. The extracts collected from the industrial area tended to show greater effects than those from the urban area. These results suggest that organic components of PM2.5 affect the respiratory and immune systems. These effects can differ by the collection areas. In addition, IL-6, DEC205, and CD86 can be predictive biomarkers for the respiratory and immune effects of ambient PM2.5.

[Native Aortic Valve Endocarditis Caused by Nocardia asteroides;Report of a Case].

Infection by Nocardia sp. is rare and usually affects immuno-depressed patients, such as those receiving chemotherapy and long-term steroid therapy. Cardiac involvement is uncommon and usually occurs as endocarditis. We present a case of native aortic valve endocarditis caused by Nocardia asteroides. Aortic valve translocation method was chosen because of extensive root infection with major disruption of the aortic annulus. Over 2 years after the surgery, there is no recurrence and no enlargement of the aortic annulus.

[Redo Coronary Artery Bypass Grafting Through Left Thoracotomy in Patient with Patent Left Internal Thoracic Artery Graft;Report of a Case].

A 61-year-old man was admitted because of unstable angina. The patient had a history of CABG [LITA-left anterior descending artery(LAD), aorta-saphenous vein graft(SVG)-posterolateral branch (PL)-diagonal branch (D1)]4 years ago. Coronary angiography revealed an occlusion of old SVG at proximal anastomosis site and a stenosis of native high lateral artery (HL). To reduce the risk of cardiac injury and damage to the patent grafts due at sternal reentry, we performed redo CABG through left thoracotomy. The proximal site of SVG was anastomosed to descending aorta using automated proximal anastomosis system. The SVG was anastomosed to the HL and old SVG in a sequential mode. Postoperative course was uneventful and the patient was discharged on postoperative day 14. Redo CABG through left thoracotomy provides safe and effective surgical approach in patient who requires revascularization of left circumflex territory.

Aortopulmonary artery fistula: ruptured aneurysm of the distal aortic arch into the pulmonary artery.

Aortopulmonary artery fistula is uncommon, but the clinical outcome is often lethal. A 76-year-old man with a history of acute thoracic aortic dissection 6 years previously was admitted with dyspnea. A chest x-ray showed pleural effusion and pulmonary congestion. Transthoracic echocardiography revealed preserved systolic function, but continuous and abnormal flow from the distal aortic arch into the pulmonary artery (PA). Transesophageal echocardiography (TEE) in the Doppler color-flow mode demonstrated a left-to-right shunt between a large distal aortic arch aneurysm and the left PA via an aortopulmonary fistula and a pressure gradient across the shunt of 56 mmHg. Contrast-enhanced computed tomography showed that the aneurysm compressed the PA. Aortography also revealed a large distal aortic arch aneurysm and almost simultaneous contrast enhancement of the aorta and the PA. Right-heart catheterization showed a significant increase in oxygen saturation between the right ventricle and the PA. A left-to-right shunt due to a distal aortic arch aneurysm rupturing into the left PA was diagnosed based on these findings. TEE was very helpful in confirming the presence and precise location of the fistula.

Electrocardiographic QRS Findings Upon Admission Can Predict Prognosis of Acute Myocardial Infarction Caused by Occlusion of Left Main Coronary Artery.

BACKGROUND: Acute myocardial infarction (AMI) caused by left main coronary artery (LMCA) occlusion is associated with a severe clinical course and catastrophic consequences. HYPOTHESIS: We sought to clarify ECG predictors of prognosis in AMI caused by LMCA occlusion. METHODS: We examined 20 consecutive patients with AMI caused by LMCA occlusion that was treated by primary stenting. The patients were assigned to either a group that survived (S) and was discharged from hospital, or a group that did not survive (NS) and died in hospital. We compared ECG findings upon admission, angiographic findings, laboratory data and clinical outcomes. RESULTS: The rate of having Thrombolysis In Myocardial Infarction (TIMI) grade > 2 coronary flow before PCI and of achieving TIMI grade 3 after PCI was significantly lower in the NS than the S group (14.3% vs. 83.3%, p = 0.003 and 35.7% vs. 100%, p = 0.008). The ECG findings showed longer QRS interval in the NS than in the S group (150.5 ± 37.9 vs. 105.2 ± 15.4, p = 0.022). A QRS interval ≥ 120 msec predicted in-hospital mortality with sensitivity, specificity and positive and negative predictive values of 78.5%, 100%, 100% and 66.7%, respectively, in this population. CONCLUSIONS: The QRS duration upon admission was a good predictor of in-hospital mortality among patients with AMI caused by LMCA occlusion. This ECG sign could be useful in the emergency clinical setting.

Earlobe Creases as a Marker of the Risk for Coronary Atherosclerosis Before Angiography in Elderly and Non-elderly Patients.

Background The close relationship between earlobe creases (ELC) and the presence of coronary artery disease (CAD) has been reported. In addition, this study aimed to determine associations between ELC and the presence, extent, and severity of coronary atherosclerosis assessed by coronary angiography in non-elderly and elderly patients. Methods We assessed 1,086 consecutive patients with suspected CAD by coronary angiography. We defined severe CAD as Gensini scores > 20. Multiple logistic regression analysis was adjusted for age, sex, hypertension, diabetes mellitus, smoking status, lipid profiles, and body mass index (BMI) to assess the presence or absence of CAD, multivessel disease, and severe CAD in elderly (age ≥ 60 years) and non-elderly (age < 60 years) patients. Results ELC was a significantly positive determinant of CAD (odds ratio (OR) = 3.074, p < 0.001), multivessel disease (OR = 3.101, p < 0.001), and severe CAD (OR = 2.823, p < 0.001) in all patients. ELC was also a predictor of CAD, multivessel disease, and severe CAD not only in patients aged ≥ 60 years (OR = 3.095, p < 0.001; OR = 3.071, p < 0.001; OR = 2.761, p < 0.001, respectively) but also in those aged < 60 years (OR = 2.749, p = 0.035; OR = 2.634, p = 0.038; OR = 2.766, p = 0.006, respectively). Conclusions ELC was independently associated with the presence of CAD, multivessel disease, and severe CAD in both elderly and non-elderly patients who were assessed by coronary angiography.

Heat Stroke-Induced Takotsubo Cardiomyopathy With a Concomitant Transient Brugada-Like Electrocardiogram.

A 79-year-old man presented with impaired consciousness, fever with a body temperature of 41.1°C, and an electrocardiogram showing significant ST segment elevation in leads V1-6, coved-type ST elevation in leads V1-3, and partial right bundle branch block. Echocardiography revealed notable left ventricle dysfunction with apex-based akinesis. Coronary angiography confirmed severe obstructive lesions but left ventriculography displayed the distinct apical ballooning of takotsubo cardiomyopathy (TC). This case highlights the presence of atypical electrocardiographic patterns in TC influenced by comorbidities, supporting the diagnosis of TC despite concurrent obstructive coronary artery disease.

An Escherichia coli-Induced Distal Arch Aneurysm Presenting With Hemoptysis.

Infected thoracic aneurysms are a rare and potentially life-threatening condition that present with non-specific symptoms. We describe here a case of an 83-year-old female who presented to the emergency department with the chief complaint of vomiting blood. The patient had presented to the emergency department 40 days earlier with abdominal pain, fever, and leukocytosis. She had a medical history of traumatic liver injury resulting in bile duct stenosis, necessitating percutaneous transhepatic gallbladder drainage and subsequent bile duct-jejunal anastomosis 25 years ago. Emergency contrast-enhanced computed tomography (CT) revealed an irregular distal arch aneurysm. According to the patient's present symptoms, CT findings, and medical history, infected thoracic aneurysm was suspected. Total arch replacement was performed promptly, followed by thorough antibiotic therapy. Following successful treatment, the patient's condition stabilized, and she was transferred to a rehabilitation facility for further recovery.

Distal Arch Aneurysm Discovered With Dysphagia.

A 64-year-old man sought medical attention from a family physician, expressing concerns about dysphagia. Recognizing the complexity of the symptoms, the family physician promptly engaged the expertise of an attending physician at a regional hospital to ensure accurate diagnosis and management. Plain computed tomography (CT) revealed a space-occupied lesion located posterior to the trachea. Although mediastinal tumor was suspected at first, contrast-enhanced CT revealed a distal arch aneurysm that compressed the esophagus. The patient underwent total arch replacement, and the postoperative course was uneventful.

Posterior Mitral Leaflet (PML) Perforation due to Infective Endocarditis (IE) Complicated with Cerebral Infarction.

A 64-year-old man on dialysis presented to the emergency department with a fever and chills. Transthoracic echocardiography (TTE) showed small vegetation on the posterior mitral leaflet (PML). Antibiotic therapy was initiated. Two weeks later, right hemiparesis occurred. MRI of the head showed occlusion of the left middle cerebral artery, which suggested an embolism derived from the vegetation. The patient was then referred to the department of cardiovascular surgery. Transesophageal echocardiography (TEE) revealed perforation of the PML and severe mitral regurgitation (MR). The patient underwent mitral valve repair. The postoperative course was uneventful, and the patient was discharged after six weeks of antibiotic treatment. A fresh autologous pericardium is the material of choice to repair the valve.

Worsening Isolated Superior Mesenteric Artery Dissection on the Day After Discharge.

A 59-year-old male was transported to the emergency department by ambulance with complaints of left-sided abdominal pain. Blood gas analysis revealed elevated lactate, and plain computed tomography revealed no bowel ischemic change. Contrast-enhanced computed tomography revealed isolated superior mesenteric artery dissection with mildly stenosed true lumen. The patient was treated with conservative management on admission. Staged fluid intake, oral prescriptions, and diet were commenced with attention to the symptoms. After four days of hospitalization, the patient was discharged with a stable condition. However, the patient returned to our hospital complaining of left lower back pain three hours after discharge. Contrast-enhanced computed tomography revealed an enlarged false lumen with a moderately stenosed true lumen. After a thorough discussion between vascular surgeons and interventional radiologists, conservative management was commenced on the second admission. The clinical course was uneventful, with proof of improved imaging findings.

Posterior Mitral Leaflet Prolapse and Subsequent Mitral Valve Endocarditis Complicated With Anterior Leaflet Perforation.

A 68-year-old male presented with a two-week history of fever, and further investigations revealed mitral valve endocarditis caused by Staphylococcus epidermidis, with associated severe mitral regurgitation (MR). The patient was referred for mitral valve surgery but developed new neurological symptoms two days before the operation, which were diagnosed as symptomatic epilepsy. During surgery, kissing lesions were found on the posterior mitral leaflet (PML), which were not detected on preoperative transesophageal echocardiography (TEE). Mitral valve repair was completed using autologous pericardium. The current case highlights the importance of careful examination of leaflets during surgery and not relying solely on preoperative imaging to detect all lesions. It is essential to promptly diagnose and treat infective endocarditis to prevent further complications and ensure successful outcomes.

Predictors of In-Hospital Death in Patients With Acute Myocardial Infarction.

OBJECTIVE: Factors such as age, vital signs, renal function, Killip class, cardiac arrest, elevated cardiac biomarker levels, and ST deviation predict survival in patients with acute myocardial infarction (AMI). However, the existing risk assessment tools lack comprehensive consideration of catheter-related factors, and short-term prognostic predictors are unknown. This study aimed to clarify in-hospital prognostic predictors in hospitalized patients with AMI. METHODS: Five hundred and thirty-six patients who underwent percutaneous coronary intervention (PCI) for AMI were divided into non-survivor (n = 36) and survivor (n = 500) groups. Coronary risk factors, laboratory findings, angiographic findings, and clinical courses were compared between the two groups. Multiple logistic regression was used to analyze in-hospital death in pre- and post-PCI phases. RESULTS: In the pre-PCI phase, multiple logistic regression analysis revealed several predictors of in-hospital death, including systolic blood pressure [odds ratio (OR) = 0.985, p = 0.023)], Killip class ≥2 (OR = 14.051, p <0.001), and chronic kidney disease (OR = 4.859, p = 0.040). In the post-PCI phase, multiple logistic regression analysis revealed additional predictors of in-hospital death, including Killip class ≥2 (OR = 5.982, p = 0.039), presence of lesions in the left main trunk (OR = 51.381, p = 0.044), utilization of intra-aortic balloon pumps and percutaneous cardiopulmonary support (OR = 6.141, p = 0.016), and presence of multi-vessel disease (OR = 6.323, p = 0.022). CONCLUSION: Predictors of in-hospital death in AMI extend beyond conventional risk factors to include culprit lesions, mechanical support, and multi-vessel disease that manifest post-PCI.

Type A Acute Aortic Dissection Presenting With Arch and Abdominal Aortic Aneurysms.

Herein, we present the case of an 89-year-old female who presented with acute aortic dissection involving the arch and abdominal aneurysms. Emergent total arch replacement with a frozen elephant trunk was the first-line approach taken to save the patient's life. Although prolonged mechanical ventilation necessitated a tracheostomy, subsequent endovascular aortic repair mitigated the risk of rupture in the abdominal aortic aneurysm. While managing acute aortic syndrome with multiple aneurysms poses a challenge for surgeons, a diagnosis based on computed tomography angiography and timely intervention alleviated the critical condition.

Pulsatile thrombus evacuation from the false lumen of an occluded carotid artery in acute aortic dissection.

Herein, we present a case of aortic dissection with right carotid artery occlusion that was treated successfully with thrombus evacuation from the false lumen of the occluded carotid artery during hemiarch replacement. This procedure is performed with two maneuvers: aggressive retrieval of the thrombus from the innominate artery during circulatory arrest and thrombus evacuation from the false lumen of the right common carotid artery through a right neck incision with the heart beating. In this alternative method, thrombi can be evacuated more naturally and briskly, using pulsatile flow.

Management of Coronary Artery Bypass Grafting Using an Arteriovenous Fistula: An Intraoperative Change in the Preoperative Plan.

Regarding coronary artery bypass grafting (CABG) in patients on hemodialysis, in situ internal thoracic artery (ITA) grafting of the left anterior descending artery (LAD) improves survival and freedom from cardiac events. Although a problem with the ITA can possibly occur, using the ITA ipsilateral to an arteriovenous fistula (AVF) in the upper extremity of patients on hemodialysis can cause coronary subclavian steal syndrome (CSSS). CSSS is a condition of myocardial ischemia caused by the diversion of blood flow from the ITA following coronary artery bypass surgery. CSSS has been reported to occur in cases of subclavian artery stenosis, AVF, and low cardiac function. A 78-year-old man with end-stage renal disease experienced angina pectoris during hemodialysis. The patient was scheduled for CABG, including anastomosis of the left internal thoracic artery (LITA) and LAD. After completion of all anastomoses, the LAD graft demonstrated retrograde blood flow, suggestive of ITA anomalies or CSSS. The LITA graft was transected at the proximal part and anastomosed to the saphenous vein graft with sufficient flow to the high lateral branch eventually.